<%-- 
    Document   : feedback
    Created on : May 22, 2012, 6:42:57 PM
    Author     : KIRAN
--%>

   <html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=windows-1252" />
<title>Citizens Page</title>
<link rel="stylesheet" type="text/css" href="style.css" />
</head>
<body>

<div id="main_container">
	<div id="header">
    	<div id="logo"><a href="index.html"><img src="images/title.gif" alt="" title="" border="0" /></a></div>        
<div class="blog_title"><h5 align="right"><a href="index.jsp">LogOut</a></h5></div>

        <div id="menu_tab">                               
                <ul class="menu">                         
                     <li><a href="home.jsp" class="nav_home"> HOME </a></li>
                     
                     <li><a href="services1.jsp" class="nav_about"> SERVICES</a></li>
                     <li><a href="feedback.jsp" class="nav_services"> Feedback</a></li>
                     <li><a href="contact1.jsp" class="nav_contact"> CONTACT US </a></li>
                </ul>
        </div>        
        
        
    </div>
    
  
   
            <div class="blog_title">
            <form action=""  method="post">
<table>
<tr>
	<td width="252"><div align="right">Citizen's Name:</div></td>
	<td width="293"><input type='text' value='' size='' name='field18'></td>
</tr>
<tr>
	<td><div align="right">Citizen's Address:</div></td>
	<td><input type='text' value='' size='' name='field19'></td>
</tr>
<tr>
	<td><div align="right">Phone Number:</div></td>
	<td><input type='text' value='' size='' name='field20'></td>
</tr>>
<tr>
	<td><div align="right">E-mail Address</div></td>
	<td><input type='text' value='' size='' name='field21'></td>
</tr>
<tr>
	<td valign="top"><div align="right">Comments and Suggestions 
	  on Services:</div></td>
	<td><textarea cols='40' rows='5' name='field22'></textarea></td>
</tr>

</table>
</form>
                <center><input type="submit" name="Submit" value="Submit" />
        <input type="reset" name="reset" value="Reset" /></center></div>
          
            <br><br><br> <br><br><br> <br><br> <br><br><br>    
    
            
            
            
            
          

</div>
</body>
</html>